Medicare Benefits

Accountable Care Organizations are New in 2012 for Medicare

Health insurance in general is a topic that has created many firestorms in recent years as we all start to agree that some inequities exist.  New programs continue to pop up for all health insurance companies to overcome this and Medicare has joined the fray as well.  Accountable Care Organizations (ACOs) have been added by Medicare in 2012 to help improve the health insurance experience overall. Read more…

The Medicare Part D Coverage Gap Continues

Medicare, like many insurance companies, has made some mistakes over
the years that they are trying to correct with recent changes.  One of
these mistakes was a coverage gap that left many people struggling to
pay for medications that they needed.  Now, you can get help, though
it won’t pay for everything.  Here is a brief synopsis of what you
will pay when you reach the coverage gap. Read more…

Dialysis Treatments and Medicare


Dialysis can be a very important treatment for many people with a medical condition and this is why Medicare takes special steps to assist you with the treatment.  With the Medicare coverage that you have it is possible that much of the dialysis treatment you need will be covered by your policy.  This doesn’t mean that you won’t pay anything, but it could save you a lot of money. Read more…

Colonoscopy and Your Medicare Coverage


Avoiding cancer is hard sometimes when you are at high risk due to family history and this makes it hard on your bank account.  Screenings and testing in trips to the doctor’s office aren’t cheap, but they can become cheaper thanks to your Medicare coverage.  Medicare covers this test once every 24 months if you’re at high risk for colorectal cancer. Read more…

Colorectal Cancer Screening and Barium Enema with Medicare

Treatment for colon cancer, and most types of cancer, is most effective when it is found early.  With this in mind most insurance companies will cover preventative testing to find out if a cancerous growth exists.  One of these procedures is a barium enema and it is covered for all Medicare patients over the age of 50. Read more…

What is Medicare Reconsideration?

When you start to talk about health insurance or Medicare it is likely that you will get some unkind looks and the story will end fast.  It is important to offset this by learning something about the process and how it will work if things aren’t concluded.  You need to know how the process works when you get a claim and what happens if you don’t agree with it. Read more…

Diabetes Screenings and When Medicare Offers Coverage

To take good care of yourself with Diabetes you must be serious and consistent as it is a serious condition. The financial strain that comes with keeping up with diabetes is almost as difficult to deal with as the physical strain. To maintain normality in your life you must have check-up kits and needles available quite often. Read more…

Facts About Medicare Part A Claim Detail

It is sometimes difficult to handle Medicare Part A inpatient claims as the invoices will be filled with such a big volume of information. Some of this may be confusing to you and that is what the goal of this information will be. A few things that should be of interest to you with your Medicare Part A inpatient claim are listed below. Read more…

Is Important?

There is no question about it these days, if you want to get anything done in this world you can probably do it on the internet. User friendly applications and efficiency are important reasons to make your business convenient online. One way for Medicare users to do this is to register with so that they can access their Medicare account.

Here are a few things you can do with

1. Access your personalized information at any time. As your Medicare claims are processed you will be given access to Medicare-specifics that you may need. Your overall experience with Medicare will then change forever.

2. With you will have access to your preventive service information as well as your entitlement and eligibility. This will give you access to the information that medical offices will want to know and you don’t remember.

3. Your prescription drug enrollment information and your Part B deductible information along with your prescription drug list will be available. An accurate assessment of your medical needs can then be made if you go do the doctor for a medical assessment.

Medicare Benefit Period Facts

A benefit period is not something that is unique to Medicare, but it is something that is defined a little differently in their world. If you are entering a skilled nursing facility or a hospital it may be beneficial to you to know this definition. The day you enter a skilled nursing facility or a hospital your Medicare benefit period will begin, this is important to know. Read more…

Does Medicare Cover Smoking Cessation Counseling to Stop Smoking?

Smoking affects more and more people every day in many different ways from the people that actually smoke to the people that simply inhale it.  Due to the effects that tobacco can have on the body in addition to simply the effect that smoke can have it is important to help people quit if possible.  Part of the role of Medicare as a health insurance provider is to provide education for people in regards to their health, this definitely applies with smoking cessation counseling. Read more…

Is EKG Screening Covered Under Medicare?

When you first start your Medicare coverage in your lifetime there will be a very important exam that you will get first thing.  This exam is often referred to as the “Welcome to Medicare” physical exam and it will test for many different possible health issues.  Among them is the possibility of having heart disease and if you appear to be at risk you could be referred for an EKG screening. Read more…

What is the Medicare 12 Month Rule for Mammograms?

Mammograms are very important for all women to get, especially women who are over the age of 30 due to the prevalence of breast cancer.  To try to fight and prevent this ugly disease most health insurance companies will allow for some screenings to be done without charge.  This preventive screening is also covered by Medicare but there are a few restrictions you should be aware of, such as the 12 month rule. Read more…

What are the Medicare Inpatient Benefits?

An unexpected stay in a hospital can be bad enough for the emotional and physical reasons, the financial destruction is yet another byproduct. People who are enrolled in Medicare may not know what to do if they are suddenly and unexpectedly thrown into the hospital for a stay. Just what benefits are available to Medicare subscribers for this situation can be confusing so here is a little background. Read more…

Does Medicare Cover Cardiac Rehabilitation Program

With so many different potential ailments or conditions that people could have there is often an unknown element to Medicare for so many people.  It can sometimes become very frustrating and confusing when you don’t know what is paid for.  When you are recovering from a heart attack this is not a good approach to have in your life.
Medicare Part B covers Cardiac Rehab programs that will help you recover as long as your doctor recommends it and you have had:
• A heart attack in the last 12 months
• Coronary bypass surgery
• Current stable angina pectoris (chest pain)
• Heart valve repair/replacement
• Angioplasty (a medical procedure used to open a blocked artery) or coronary stenting (device used to keep an artery open)
• A heart or heart-lung transplant
As you can see, Medicare benefits are there to help you when you are in a crisis as long as you know where to look and what you are looking for.  Taking part in rehabilitation exercises to help you build up strength and regain some of your normal functions in life is worth your time and Medicare’s money.  Medicare will pay all but 20% of the fee to have this done unless you have outpatient procedures done, in which it would be a copay for your portion of the claim.

Speech-Language and Occupational Therapy Benefits through Medicare

Medicare is like most health insurance carriers in that they provide benefits for services that will improve your health or quality of life.  Two services that fall under this realm are speech-language therapy and occupational therapy as they help you handle day to day stresses and frustrations.  These benefits will help you incur the financial strain involved with getting therapy.
Medicare defines these services as follows: “…Speech-language therapy (pathology services) includes exercise to regain and strengthen speech skills.  Occupational therapy includes exercise to help you do usual daily activities by yourself. You might learn new ways to eat, put on clothes, comb your hair, and perform other usual daily activities. You may continue to receive occupational therapy if ordered by your doctor even if you no longer need other skilled care…”
If you feel that you qualify for these services you should talk to your doctor or another medical professional as soon as possible.  You could be paying for services that are covered under the Medicare policy that you have and are paying premiums for.  Ask your doctor specifically if you qualify for these services and make a point of telling him or her that you think this could improve your quality of life.  Don’t quit trying to get the services that you are contractually able to receive.

Random Facts About Medicare Part B

Medicare has about as many twists and turns as a road in the Rocky Mountains and this causes a lot of facts to fall through the cracks.  Instead of waiting for a time to cover everything about certain services in a separate article we decided to throw a few random things into one group.  Here are a few random things you may or may not know about Medicare Part B: Read more…

Getting the $250 Donut Hole Rebate for Medicare Part D

There is an endless amount of ways that you can get in to financial trouble trying to pay your insurance premiums, one being paying for prescription drugs.  In the past there was no relief for anyone hitting the coverage gap known as the donut hole, you hit it and you were out money.  For this year only there is help for you and if you have hit the coverage gap you will be receiving a $250 payment in no time. Read more…

Medicare Benefits Cover Diabetes Self-Management Training

Being diagnosed as a diabetic is not a fun moment for anyone that has the unfortunate experience in their life.  You must change your entire life to treat the condition and it becomes a very difficult situation to overcome in your existence.  However, with the help of your Medicare insurance you can get help with your diabetes and live a better life.

If you are not familiar with Diabetes Self-Management Training it is an amazing training experience that will help you deal with your lifestyle.  The course includes education about self-monitoring of your blood glucose as well as your diet and exercise.  On top of that you have the opportunity to learn a little more about the insulin that becomes so important to your life.

Read more…

Medicare Part A: Is Blood Paid for?

The very question in and of itself is terrifying and very grim, but the question has been asked by many a Medicare patient, is the blood I need covered?  Many people don’t realize that some of your Medicare Part A coverage may kick in when this situation arises.  If you are in the situation that you need blood don’t wait on your insurance to decide if it will be covered or not. Read more…

Medicare Benefits and the Obama Healthcare Plan

The Obama Healthcare Plan has been in the news for the last couple of years now and it is even more pressing news as the plan is so close to being in force.  Many people are aware of the effects that the plan will have on the private insurance companies in the country, but how will it affect Medicare benefits?  Are there changes that could happen soon to Medicare benefits that Medicare beneficiaries should know about?

One of the biggest and possibly soonest changes under the new healthcare plan to Medicare benefits is the free checkups and screenings.  This is part of Obama’s changes that he wants in force next year and it would entitle all beneficiaries, even if they do not change insurance plans, to get a free annual checkup and free screening.  These changes would benefit thousands or possibly millions of Medicare beneficiaries across the country.

The free screenings could include preventative measures such as colonoscopies and mammograms, which would be a relief to many.  These changes to Medicare benefits have not been made or put in force yet, but the final steps are being walked in Washington right now.  Be sure to check back for other possible changes to Medicare benefits with the new healthcare plan.

Medicare Part B: Are Colorectal Cancer Screenings Covered?

Medicare Part B will help you cover yourself in the event that you need services to help detect or treat a major medical illness.  With Medicare Part B there are some services that are covered directly while others are covered in part by Medicare and the rest is left to you.  There are some tests for Colorectal Cancer that are covered by Medicare Part B and they are outlined below.

  • Fecal Occult Blood Test—Once every 12 months if age 50 or older. No cost for the test, but you generally have to pay 20% of the Medicare-approved amount for the doctor’s visit.
  • Flexible Sigmoidoscopy—Generally, once every 48 months if age 50 or older, or 120 months after a previous screening colonoscopy for those not at high risk. You pay 20% of the Medicare-approved amount.
  • Colonoscopy—Generally once every 120 months (high risk every 24 months) or 48 months after a previous flexible sigmoidoscopy. No minimum age. You pay 20% of the Medicare-approved amount.
  • Barium Enema—Once every 48 months if age 50 or older (high risk every 24 months) when used instead of a sigmoidoscopy or colonoscopy. You pay 20% of the Medicare-approved amount.

Again, if you think you are going to have to use Medicare Part B for any of the above you should always consult your doctor first.

Do You Qualify for Medicare Part D Extra Help?

Medicare Part D is what assists you in paying for your prescription drugs and the Federal Government realizes that this process may be more expensive for some than others.  If you are someone who requires a lot of prescription drugs and Medicare Part D alone doesn’t seem to give you enough, it is time to consider the “Extra Help” program.  Qualification for Medicare Part D Extra Help is not easy for everyone, but you may have an automatic qualifier.

Here are three ways that you may qualify for Medicare Part D Extra Help.  You only have to be able to answer yes to one of these questions.

  • You have full Medicaid coverage.
  • You get help from your state Medicaid program paying your Part B premiums (belong to a Medicare Savings Program).
  • You get Supplemental Security Income (SSI) benefits

If you qualify based on one or more of the preceding points then you could get Medicare Part D Extra Help to give you a little more assistance.  Understand that there are other possible income requirements, but being a part of one of the above groups will likely include you in those requirements as well.

What Services are Not Covered by Medicare Part A?

When you are enrolling in your Medicare benefits it is always good to know what you can and cannot get from a particular coverage, such as Medicare Part A.  Medicare Part A generally has to do with hospital insurance and similar things related to a hospital stay being covered.  However, it is not just beneficial to know what is covered, it will help you to know what is not covered by Medicare Part A.

Medicare Part A does not cover the following:

•Private duty nursing is not covered and should not be considered a part Medicare Part A.  This will likely have to be covered by personal funding.

•A television or telephone in your room or personal care items like razors or slipper socks will not be covered by Medicare Part A.  Make sure you have someone that can bring you these things while you are in the hospital.

•A private room unless medically necessary will not be covered by Medicare Part A.  This is viewed as being an extra benefit not a necessity.

•The first three pints of blood unless the blood deductible has been met will not be covered by Medicare Part A.  This is good to know if you have already paid your deductible for the year.

The doctor services you get while you are in a hospital may be filed under Part B.  Don’t forget that some of the above may also be covered under other parts of Medicare, but not under Medicare Part A.

Medicare Benefits: Out-of-Pocket Costs with Original Medicare

Insurance is costly enough if you simply have to pay the premiums that come along every month, but what about the costs that aren’t included with Medicare benefits?  The out-of-pocket costs that aren’t discussed freely are usually where you start to lose your tie when trying to pay for medical bills.  Medicare benefits are similar to all other forms of insurance in that some things you have to take care of independently. 

How to decide if you will pay out-of-pocket with Medicare benefits:

  • Your out-of-pocket costs could be greatly reduced if you inform your doctors that you want to sign a Medicare benefits private contract.
  • Be very honest when explaining the type of health care and why you need it when trying to get enrolled.  You’ve got to know that this will affect your pocketbook if you enroll in Medicare benefits that don’t suit you.
  • If you choose to get Medicare services or supplies that are not covered by your Medicare benefits they will be charged at full cost to you.  In other words, be careful that the Medicare benefits you enroll in are the benefits that you need to survive.

In short, the message is this, the more research you do during enrollment the more of a chance you have to pay lower out-of-pocket costs.  Medicare benefits can only take you as far as you allow them to.